OPINION

Surprise Billing Legislation Must Rein In Insurance Companies

Surprise medical billing is an element of our health care system that exerts undue stress on American families and makes it difficult for them to recover, both healthwise and financially, from something as necessary as a visit to the emergency room. A recent University of Chicago study found that nearly 6 in 10 Americans have been hit with a surprise medical bill for services their insurance company refuses to cover, and the burden falls onto the patient.

As someone who lives with acromegaly — a condition caused by a growth hormone imbalance — I have felt the weight of a surprise medical bill. Acromegaly can complicate a number of bodily functions and is often associated with conditions like hypertension and diabetes. Unfortunately, it lands our patients in the emergency room more than the average person, and while there, we may receive treatments that are not covered by insurance — something not realized until a surprise medical bill is received in the mail.

The problem here remains that insurers, who often use algorithms to determine costs, aren’t considering the spanning impact of conditions and the holistic treatment plan it requires. It is imperative that we push insurers to end the practice of forcing people to use out-of-network health care facilities.

Over the last few months, however, it has been heartening to see that lawmakers in Washington are taking steps to address surprise medical billing, to make life easier for citizens/patients like myself. A few bills were introduced in 2019 and put through a rigorous legislative process in Congress.

Any law to end surprise medical billing must include two core features. First and foremost, it must protect patients. Second, it should provide a reasonable reimbursement payment mechanism to settle coverage disputes between providers and insurers.

From this time forward, patients should be able to attend to their well-being without the mental anguish that comes with surprise medical bills.

It is also important to remember the problem in this equation: insurance companies. We have to be mindful not to pin blame singularly on health care providers because drastic cost-cutting will likely lead to marked decline in the quality of medical care available to some of the most vulnerable populations in our society.

Vulnerable communities are often underserved and include poor families, differently abled, senior citizens, people of color and so on. Therefore, balance is key. The ideal solution to end surprise medical billing would be careful not to undermine the economic viability of hospitals and clinics while striving to protect patients and their access to quality care.

One thing is clear: In order to find a viable solution, our lawmakers need to work together.  Although we know cooperation across the aisle is not their strongest suit, surprise medical billing is the one issue in Congress with bipartisan support. Ailing citizens should not be hit with surprise medical bills that can add financial burden onto an already trying time. 

It’s time to act on that agreement. We live in a nation that is one of the best in the world; isn’t it time we protect our ailing communities too?

 

Jill Sisco is president of the Acromegaly Community.

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